Sign up for TPR Today, Texas Public Radio's newsletter that brings our top stories to your inbox each morning.
UT Health San Antonio Multispecialty and Research Hospital (MSRH) has approved a non-narcotic painkiller called suzetrigine as a first-line treatment for post-surgery pain. The hospital is the first in Texas to do so.
The medication, sold as Journavx, is the first new type of pain reliever to be approved by the Food and Drug Administration in more than 25 years.
”It's what they call first in class, this medication. There's no other medicine that's like it,” said Dr. Lee Rogers, the hospital's chief of podiatry.
Suzetrigine was approved by the Food and Drug Administration to treat acute pain in January, and MSRH quickly began considering it as a post-surgical option, Rogers explained.
"It's part of our multimodal pain management strategy for post-operative pain to help keep people off of opioids," he added, "which not only have a lot of side effects, but can sometimes be an unintended gateway to other drug use."
The difference between this medication and opioid pain relievers — and why it’s an exciting option for medical professionals — is that it doesn’t have the same side effects as medications like fentanyl, oxycodone, and hydromorphone, which can include dependence and death.
It all comes down to how people feel pain.
Pain is a sensation humans experience when injured. But there’s no pain without the brain.
Pain is perceived by nerves that create a network throughout the body, called the peripheral nervous system. It’s peripheral because it fans out along the periphery of the central nervous system, which includes the brain and spinal cord. Nerves in the peripheral nervous system experience damage, but pain isn’t immediately felt. There is an imperceptible time lapse that occurs when the knowledge of damage shoots through the nerves to the brain, and the brain says, “Oh! That’s damage!” And then someone feels pain.
Opioid medications work by depressing the central nervous system — the brain and spinal cord. They interact with central nervous system proteins called opioid receptors, interfering with those signals coming from the site of an injury to be interpreted by the brain.
This reduces the perception of pain, but it also causes sedation, sensations of pleasure, and even euphoria. Use of opioid medications can lead to dependence and even addiction. Opioids can also kill because the central nervous system is responsible for breathing. When it's depressed by opioid use, it can interfere with the signals that regulate breathing.
Suzetragine is a non-opioid analgesic, meaning it relieves pain without interacting with opioid receptors in the central nervous system. It does its work in the periphery. When damage occurs, whether by accidental injury or surgery, suzetragine blocks the pain signal right there, in the peripheral nervous system, before it reaches the central nervous system to be interpreted by the brain as pain.
There is no sedation and no euphoria. Rogers said there are reports of side effects.
“In the study, the side effects were pretty minimal,” Rogers said. “Less than 2% of patients had any side effects, and most were itching or some muscle pain.”
This is a relief to doctors, particularly those in fields like podiatry and orthopedics, in which patients are often encouraged to get active not long after surgery to speed up their recoveries.
"It's really the podiatric and orthopedic surgeons that have spearheaded this at MSRH, because of joint replacements and spine surgery and for podiatry, people walking on their feet," Rogers, a podiatrist, said. "We need to be able to get people active quicker."
He explained that it’s inhumane to expect patients to begin therapies that can be extremely painful without relief, but opioids require great care when prescribing.
Rogers said, when they prescribe them, they often also prescribe potentially life-saving naloxone, a medication used to rapidly reverse the effects of an opioid overdose.
“So this is something that I think a lot of doctors will welcome, having this alternative and something that's a safe alternative,” Rogers said.
But does it work? Rogers said it does. Doctors measure pain through patients' reports, using a pain scale of one to 10. A patient who reports a 10 is in extreme pain.
“Patients that we've had that are in an eight to 10-out-of-10 in pain ... within one hour of the first dose, they're somewhere between one and two on a scale of one to 10," Rogers said, "which is pretty good.”
All of this makes suzetrigine a game-changer in health care, Rogers concluded.
“We've never had anything that is this effective at relieving pain, that comes with as few side effects and no addiction potential,” he said.
The FDA so far has only approved suzetrigine for acute pain treatment. It is being studied as a treatment for chronic pain, a condition that also leaves people vulnerable to dependence on opioid painkillers.
"They're going to find ways to make the medicine even more effective in years to come," Rogers said. "So I think this is really turning the corner."
